Anxiety Disorders Flashcards
Generalized Anxiety Disorder
general
Genetic tendency, high correlation with traumatic event and depression; usu onset before 65 yoa
Constant worry that something bad is going to happen which impairs life
Often have co-occurring psych dx, especially mood disorder
Chronic, low-level, insidious anxiety- worry about most things most of the time
Often develop physical symptoms and panic attacks
“constant state of worry” > 6 months, > 3 somatic complaints
Change in sleep, weight, irritability, concentration
Headache, stomachache, palpitations, sweating, chest pain, N/D, tingling- “anxiety hides in skin and gut”
Work up: must rule out underlying pathology
Generalized anxiety
Tx
Treatment:
Psychotherapy/CBT
Rx:
1-SSRI ( start lower doses) or -SNRI
2-buspirone
Benzodiazepine for panic attacks
Beta-blockers, TCA
Generalized Anxiety Disorder
Diagnostic Criteria DSM-V
Patient presents with insomnia, fatigue and “constant worry” about multiple things daily for > 6 months. Which of the following is best therapy for patient?
Alprazolam (Xanax)
Buspirone (Buspar)
Fluoxetine (Prozac)
Hydroxyzine (Vistaril)
C- fluoxetine. Diagnosis is Generalized Anxiety disorder. Drug of choice is SSRI + CBT
If needed add on therapy SNRI or Buspirone ( 2nd line)
Prn symptoms Vistaril, xanax
Separation Anxiety Disorder
General and Tx
uncontrollable apprehension regarding separation or loss of figure(s)
Excessive worry about something happening to figure
Symptoms > 6 months in adults; > 4 weeks in children
“normal” in children < 4 yoa
Often leads to panic disorder in adulthood
Treatment
CBT
Play-therapy (for patient and family)
Separation Anxiety
Diagnostic Criteria DSM V
Separation Anxiety Examples
Children refusing to go to school, sleep overs, camp, temper tantrums when figure leaves
“Nightmare in the closet”
Most prevalent anxiety disorder in children < 12
Can be triggered by a stressor- ie moving, changing schools, divorce, death in the family
Can present in adults too!!!
Tx: CBT
? Do you feel anxious, fearful, or upset thinking about separation, or being away from….
Adults can have separation anxiety as well- usually involve separation from child, or someone else in a relationship with
Separation Anxiety Patient Education
What is treatment of choice for separation anxiety disorder?
A- Benzodiazepine prn
B-Cognitive Behavioral Therapy
C- EMDR
D-Flooding and Graduated Exposure therapy
E-SSRI
B- CBT
Panic Disorder
general
Extreme worry/anxiety peaks within 10 minutes and declines within 30 minutes
Insidious vs identifiable trigger
Associated debilitating symptoms
3 x more common in women vs men
Onset usually in 20’s but may occur in childhood
High recurrence if medications are discontinued
Workup: r/o other pathology
Workup: depends on symptoms, must rule out underlying pathology- especially life-threatening; associated disorders
ECG, enzymes, TSH, holter, asthma, COPD
Presentation
Men greater than women, age 20’s
Panic Disorder
Tx
Acute phase: benzodiazepine ( caution)
CBT
Chronic phase: SSRI, TCA
* may see beta blockers ( propranolol)
* may see antihistamine ( hydroxyzine)
Treatment
Acute: benzo
Chronic:1- SSRI, 2-TCA
Cognitive behavioral therapy is the mainstay of therapy-( Flooding and Graduated Exposure) improvement from chronic Rx therapy likely due to improved underlying GAD
Panic disorder
Diagnostic criteria
A. Recurrent unexpected panic attacks. A panic attack is an abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time four (or more) of the following symptoms occur:
Note:The abrupt surge can occur from a calm state or an anxious state.
Palpitations, pounding heart, or accelerated heart rate.
Sweating.
Trembling or shaking.
Sensations of shortness of breath or smothering.
Feelings of choking.
Chest pain or discomfort.
Nausea or abdominal distress.
Feeling dizzy, unsteady, light-headed, or faint.
Chills or heat sensations.
Paresthesia (numbness or tingling sensations).
Derealization (feelings of unreality) or depersonalization (being detached from oneself).
Fear of losing control or “going crazy.”
Fear of dying.
B. At least one of the attacks has been followed by 1 month (or more) of one or both of the following:
Persistent concern or worry about additional panic attacks or their consequences (e.g., losing control, having a heart attack, “going crazy”).
A significant maladaptive change in behavior related to the attacks (e.g., behaviors designed to avoid having panic attacks, such as avoidance of exercise or unfamiliar situations).
C. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism, cardiopulmonary disorders).
D. The disturbance is not better explained by another mental disorder (e.g., the panic attacks do not occur only in response to feared social situations, as in social anxiety disorder; in response to circumscribed phobic objects or situations, as in specific phobia; in response to obsessions, as in obsessive-compulsive disorder; in response to reminders of traumatic events, as in posttraumatic stress disorder; or in response to separation from attachment figures, as in separation anxiety disorder).
Panic Attack Unprovoked, acute
S: shortness of breath
T: trembling
U: unsteady
D: depersonalization
E: excessive heart rate
N: numbness
T: tingling
S: sweating
P: palpitation
A: abdominal pain
N: nausea
I: inert fear/impending doom
C: chest pain
Phobias
general and tx
A situational fear (exaggerated vs irrational)
Lasts > 6 months
Can be specific vs situational
Usually learned/rooted in experience
Cannot control response to trigger
Often occur in childhood and solidify in adulthood
Often have substance abuse, chronic anxiety, and personality disorder
Treatment
CBT with exposure therapy
Specific Phobia Diagnostic Criteria
Obsessive-Compulsive Disorder
Diagnostic Criteria (300.3)
Obsessive Compulsive Disorder
Types
Hoarding Disorder
Criteria
